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Depression - Epidemiology
This article considers the epidemiology of depression amongst adults for other age groups see: “Depression is the most common mental disorder in community settings, and is a major cause of disability across the world. In 1990 it was the fourth most common cause of loss of disability-adjusted life years in the world, and by 2020 it is projected to become the second most common cause (World Bank, 1993). In 1994 it was estimated that about 1.5 million disability-adjusted life years were lost each year in the West as a result of depression (Murray et al., 1994).” Depression: the treatment and management of depression in adults, National Clinical Practice Guideline 90, The National Institute for Health and Clinical Excellence (NICE), October 2009 Global disease burden Recent review of the epidemiology of global disease again place major depressive disorder as a major contributor to the care burden of societies. These findings extend the information available from similar surveys in 1990 and 2000'. They confirm that depressive disorders are a leading direct cause of the global disease burden and show that MDD also contributes to the burden allocated to suicide and ischemic heart disease. The estimates of the global burden of depressive disorders reported in GBD 2010 are likely to be more accurate than those in previous GBD studies but are limited by factors such as the sparseness of data on depressive disorders from developing countries and the validity of the disability weights used to calculate YLDs. Even so, these findings reinforce the importance of treating depressive disorders as a public-health priority and of implementing cost-effective interventions to reduce their ubiquitous burden. Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%–10.8%) of global YLDs and dysthymia for 1.4% (0.9%–2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%–3.2%) of global DALYs and dysthymia for 0.5% (0.3%–0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%–3.8%) to 3.8% (3.0%–4.7%) of global DALYs. The researchers collected data on the prevalence, incidence, remission rates, and duration of MDD and dysthymia and on the excess deaths caused by these disorders from published articles. They pooled these data using a statistical method called Bayesian meta-regression and calculated YLDs for MDD and dysthymia using disability weights collected in population surveys. MDD accounted for 8.2% of global YLDs in 2010, making it the second leading cause of years of life lived with a disability (YLDs). Dysthymia accounted for 1.4% of global YLDs. MDD and dysthymia were also leading causes of disability adjusted life years DALYs, accounting for 2.5% and 0.5% of global DALYs, respectively. The regional variation in the burden was greater for MDD than for dysthymia, the burden of depressive disorders was higher in women than men, the largest proportion of YLDs from depressive disorders occurred among adults of working age, and the global burden of depressive disorders increased by 37.5% between 1990 and 2010 because of population growth and ageing. Finally, MDD explained an additional 16 million DALYs and 4 million DALYs when it was considered as a risk factor for suicide and ischemic heart disease, respectively. This “attributable” burden increased the overall burden of depressive disorders to 3.8% of global DALYs. So depression is a major cause of morbidity worldwide. Lifetime prevalence varies widely, from 3% in Japan to 17% in the US. In most countries the number of people who would suffer from depression during their lives falls within an 8–12% range. In North America the probability of having a major depressive episode within a year-long period is 3–5% for males and 8–10% for females. Population studies have consistently shown major depression to about twice as common in women than in men, although it is unclear why this is so, and whether factors unaccounted for are contributing to this. The relative increase in occurrence is related to pubertal development rather than chronological age and reaches adult ratios between the ages of 15 and 18, and appears associated with psychosocial more than hormonal factors. Risk factors Age People are most likely to suffer their first depressive episode between the ages of 30 and 40, and there is a second, smaller peak of incidence between ages 50 and 60. The risk of major depression is increased with neurological conditions such as stroke, Parkinson's disease, or multiple sclerosis and during the first year after childbirth. It is also more common after cardiovascular illnesses, and is related to a worse outcome. Studies conflict on the prevalence of depression in the elderly, but most data suggests there is a reduction in this age group. Unemployment and poverty Depression is often associated with unemployment and poverty. Major depression is currently the leading cause of disease burden in North America and other high-income countries, and the fourth leading cause worldwide. In the year 2030, it is predicted to be the second leading cause of disease burden worldwide after HIV, according to the World Health Organization. Delay or failure in seeking treatment after relapse, and the failure of health professionals to provide treatment are two barriers to reducing disability. Epidemiologic studies of depression are difficult to interpret because of differing case definitions and variation in diagnostic procedures between studies. For example, Boyd and Weissman (1981) reviewed the area by dividing the data into studies of depressive symptoms, bipolar disorder, and nonbipolar depression.Using this classification the reported less variation in epidemiologic rates (point prevalence, incidence, and lifetime risk) than had been noted in previous reviews. *Depression - Incidence *Depression - Prevalence *Depression - Lifetime risk *Depression - Morbidity *Depression - Mortality *Depression - Racial distribution *Depression - Age distribution *Depression - Sex distribution Epidemiology of depression by country Epidemiology of depression and comorbid conditions References Further reading Key Texts – Books Silverman, C. (1968) The Epidemiology of Depression. London : Oxford University Press Additional material – Books Key Texts – Papers *Boyd J H; Weissman M M (1981). Epidemiology of affective disorders. A reexamination and future directions. 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